Effect of Sirolimus on Intra-Abdominal adhesion development in a rat model

Objective: Postoperative intraabdominal adhesions still cause significant morbidity in surgical patients. This study aims to evaluate the effects of an immunosuppressor known as Sirolimus and an antiadhesive membrane which is formed with sodium hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm™) to the intraabdominal adhesion formation in a rat model. Materials and Methods: This experimental study was performed at an experimental research center, Yeditepe University Faculty of Medicine, Istanbul. Spraque-Dawley Rats, at a weight of about 250±20 gr, were used. Group 1 (n=8): Abdomen was closed after applying cecal abrasion (control group), group 2 (n=8): 10 x 30 mm Seprafilm™ was applied under the abdominal wall after cecal abrasion ( Seprafilm™ group ). Group 3 (n =8): Sirolimus (0,5 mg/kg) was applied (Sirolimus group). Adhesions quantitatively evaluated by a blinded assessor according to the classification of Nair and his colleagues. Results: Statistically significant difference in terms of adhesion severity scores according to the Nair classification was found between the Sirolimus and the control group (p=0,03). Whereas, no statistically significant difference was found between the Seprafilm™ and the control group (p=0,17). Similarly, no statistically significant difference was found between Seprafilm™ and sirolimus group (p=0,64). Conclusion: Although there was no statistically significant difference between intraperitoneal application of Sirolimus and Seprafilm™ group (p = 0.57), a statistically significant difference was found when each group compared with the control group (p=0,03). Combined anti-adhesive effect of Sirolimus and Seprafilm™ can be evaluated in future studies.

Is There any Effect of lycopene’s preventing peritoneal adhesion formation in rats: An Experimental Study

Objective Purpose of the study; to demonstrate the effects of lycopene on the prevention of intraabdominal adhesions in rats with biochemical, histological and macroscopic parameters. Material methods Twenty eight rats were divided into four groups consisting of 7 rats each. Group 1 [only adhesion], Group 2 [adhesion+corn oil], Group 3 [adhesion+ 5 mg/kg lycopene], Group 4 [ adhesion+20 mg / kg lycopene]. Macroscopic adhesion score, histopathological examination, Vascular endothelial growth factor (VEGF) H-score, malondialdehyde, total anioxidant capacity and VEGF values were measured in the groups. Results There were significantly higher extend [P < 0.05], severity [P < 0.05], degree [P < 0.05] and total adhesion [P < 0.05] scores in the control group and corn-oil group than in the low lycopene group and high lycopene group. VEGF H-scores were significantly lower in lycopene-given groups, regardless of dose. When low lycopene group and high lycopene group were compared in terms of anti VEGF H-score, no significant difference was observed. Malondialdehyde levels were statistically significantly lower in the control group and high lycopene group [p<0.05]. Conclusion Biochemical parameters, histopathological examination, and adhesion scoring revealed that lycopene significantly reduced adhesion formation.

Tumor necrosis factor α, protein gene product 9.5, matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 presence in congenital intra-abdominal adhesions in children under one year of age

IntroductionThe regulatory role of cytokines and extracellular matrix remodeling factors in congenital intra-abdominal adhesions has not yet been defined. The aim of this study was to assess the presence and relative distribution of tumor necrosis factor α (TNF-α), protein gene product 9.5 (PGP 9.5), matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in adhesions.Material and methodsTNF-α, PGP 9.5, MMP-2 and TIMP-2 were detected using immunohistochemical methods and their relative distribution was evaluated by means of the semiquantitative counting method. The results were analyzed using non-parametric statistical methods.ResultsA moderate number of TNF-α positive macrophages and fibroblasts was found. A positive correlation was observed between the immunoreactive structures for TNF-α and PGP 9.5. A positive reaction for PGP 9.5 was observed in nerve fibers and shape modified fibroblasts. In control group tissues, positive structures were seen in significantly higher counts for PGP 9.5. Few to moderate numbers of MMP-2 positive macrophages, epithelioid cells, fibroblasts and endotheliocytes were detected. There was no significant difference between the groups. A positive reaction for TIMP-2 was seen in fibroblasts, macrophages and endotheliocytes. In control group tissues, positive structures were found in significantly higher counts for TIMP-2.ConclusionsThe positive correlation between the immunoreactive structures for TNF-α and PGP 9.5 suggests that nerve in-growth into intraabdominal adhesions might be induced by TNF-α and PGP 9.5 could have a role in maintaining inflammation. The down-regulation of PGP 9.5 suggests that pathogenesis of congenital intraabdominal adhesions may be related to hypoxia induced damage. The imbalance between MMP-2 and TIMP-2 may prove tissue fibrosis as a response to congenital peritoneal adhesions.

A fruity bowel obstruction: ingested dehydrated apple as a cause for small bowel obstruction

Small bowel obstructions are common acute surgical presentations often as a result of intraabdominal adhesions or herniations; rarer causes include malignancies, strictures, foreign bodies and bezoars. Phytobezoars (bezoars composed of undigested plant material) account for<4% of small bowel obstructions. Here we report an unusual case of a 56-year-old male with a virgin abdomen presenting with a small bowel obstruction, a CT scan of his abdomen and pelvis was suggestive of a closed loop small bowel obstruction. The patient progressed to have an emergency laparotomy and was found to have multiple intraluminal obstructing foreign bodies within the distal ileum. On making an enterotomy to remove and examine these, they were found to be rehydrated apple segments that the patient had ingested in the dehydrated form several hours earlier. This is an example of a phytobezoar causing bowel obstruction, contributing factors to the occurrence of these include poor gastrointestinal motility and problems of mastication; in this instance the patient had poor dentition that likely pre-disposed him to this problem.